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Advanced <br />GeoEnvironmental, Inc. <br />CHAIN OF CUSTODY RECORD <br />Date 6 Page /: of 3 <br />837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1118 <br /> <br />Client I, .Ct-Ack,v/CA '&i, Ni Q1 0 Projectger <br />Tests Required <br />,._. 4 <br />Phone Numr / <br />(.0c) qb 716(--2/&,,', / Samplers: ( gnature) 0 Invoice: <br />Project Name <br />,--- <br />/ `q9 rk <br />Client <br />Sample Location Samle p <br />No. <br />Number Description Date Time Water <br />Grab. <br />T <br />Solid of .• Notes <br />Comp. Air Conts. <br />/)\V`\_.e. 60_ eti ---- 10 -0-63 70c <br />Ju <br /> , <br />'16\ --ILI / v ti:-/' <br />. <br />tt'D 27 ,. .6 --s-- <br />6 <br />-tforv 0 ec ,(,), 05 ik <br />6-0- --lb , <br />(.; /3 15- u..--a), <br />k1 /4 <br />Relinquished by: (Signature) Received by: (Signature) <br />,—/-------- <br />Date/Time <br />1-6—i6" 6 3 ic <br />/' i I <br />Date/Time Rel' uished by: (Signature Received by: (Signature) <br />Date/Time Reli ished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br />Dispatched by: (Signature) Date/Time Received for Laboratory b : <br />U-- <br />Date/Time <br />‘3 ' I I - 1 '• / ,:z <br />Method of Shipment:a <br />Zi \ie. ovc <br />atory ame , e(4------ <br />Special Instructions: I hereby authorize the performance of the above indicated work. <br />-, <br />/'-1,....'(.4 °\............._ _